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CERTIF IED PUBLIC ACCOUNTANTS LLC
Park Pl ace Profess ional Center 5871 Al lentown Road
Camp Spr ings , MD 20746 -4570 (301) 702 -9300
Fax : (301) 702 -9302 Webs ite: www.dav isr i t ter .com
DAVIS & RITTER
2019 Income Tax Return Engagement Letter
Dear Client: We are pleased to confirm our understanding of the arrangements for your income tax return(s). This letter confirms the services you have asked our firm to perform and the terms under which we have agreed to do that work. Please read this letter carefully because it is important to both our firm and you that you understand what you can and cannot expect from our work. In other words, we want you to know the limitations of the services you have asked us to perform. This engagement letter represents the entire agreement regarding the services described herein and supersedes all prior negotiations, proposals, representations or agreements, written or oral, regarding these services. It shall be binding on the heirs, successors and assigns of you and us. The Internal Revenue Service imposes penalties on taxpayers, and on us as return preparers, for failure to observe due care in reporting for income tax returns. In order to ensure an understanding of our mutual responsibilities, we ask all clients for whom we prepare tax returns to confirm the following arrangements. We will prepare the returns from information which you will furnish to us. It is your responsibility to provide all the information required for the preparation of complete and accurate returns. We may furnish you with any questionnaires and/or worksheets that you request to guide you in gathering the necessary information. Your use of such forms will assist us in keeping our fee to a minimum. Tax Preparer Responsibilities 1. We will prepare the year 2019 Federal Individual Income Tax Form 1040 and your related resident state(s) income tax form(s) and return schedules from information you furnish us. We will not audit, review, compile or otherwise verify the data you submit, although we may ask you to clarify some of the information. We are not responsible for returns prepared by other preparers. If you have taxable activity in a state/city other than that specifically listed you are responsible for providing our firm with all information necessary to prepare any additional applicable state(s)or local income tax returns as well as informing us of the applicable states. 2. We are responsible for preparing only the specific individual income tax forms for the specified reporting agencies listed in this letter. Any other required services, forms or other actions on our part require a separate engagement letter. In the absence of written communications from us documenting such services, our services will be limited to and governed by the terms of this engagement letter. Our services are not intended to determine whether you have filing requirements in taxing jurisdictions other than the one(s) of which you have requested in the paragraph above. Our firm is available under the terms of a separate engagement letter to provide a nexus study that will enable us to determine whether any other state tax filings are required. Taxpayer Responsibilities 3. Please note that any person or entity subject to the jurisdiction of the United States (includes individuals, corporations, partnerships, trusts, and estates) having a financial interest in, or signature or other authority over, bank accounts, securities, or other financial accounts having an aggregate value exceeding $10,000 in a foreign country, shall report such a relationship. Although there are some limited
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exceptions, filing requirements also apply to taxpayers that have direct or indirect control over a foreign or domestic entity with foreign financial accounts, even if the taxpayer does not have foreign account(s). Failure to disclose the required information to the U.S. Department of the Treasury may result in substantial civil and/or criminal penalties. If you do not provide our firm with information regarding any interest you may have in a foreign account, we will not be able to prepare any of the required Income Tax related forms, and penalties may be due, for which we have no responsibility. In the absence of such information being provided we will presume you do not have any foreign assets or financial interests and will not file any applicable disclosure forms without separate written authorization. 4. If you and/or your entity have a financial interest in any foreign accounts, you are also responsible for filing Form Fin Cen 114 required by the U.S. Department of the Treasury on or before April 15th of each tax year. US citizens are required to report worldwide income on their US tax return. 5. In addition, currently the Internal Revenue Service, under IRC §6038 and §6046, requires information reporting if you are an officer, director or shareholder with respect to certain foreign corporations (Form 5471); foreign-owned U.S. corporation or foreign corporation engaged in a U.S. trade or business (Form 5472); U.S. transferor of property to a foreign corporation (Form 926) ); and, for taxable years beginning after March 18, 2010, if you hold foreign financial assets with an aggregate value exceeding $50,000 (Form 8938) . These code sections describe the information required to be reported on the respective forms, which are due when your income tax return is due, including extensions. Therefore, if you fall into one of the above categories you may be required to file one of the above listed forms. Failure to timely file may result in substantial monetary penalties. By your signature below, you accept responsibility for informing us if you believe that you fall into one of the above categories and you agree to provide us with the information necessary to prepare the appropriate form(s). We assume no liability for penalties associated with the failure to file or untimely filing of any of these forms. Other Items 6. Our fee does not include responding to inquiries or examination by taxing authorities or third parties, for which you will be separately billed for time and expenses involved. However, we are available to represent you and our fees for such services are at our standard rates and would be covered under a separate engagement letter. You agree to immediately notify us upon the receipt of any correspondence from any agency covered by this letter. 7. It is your responsibility to maintain, in your records, the documentation necessary to support the data used in preparing your tax returns, including but not limited to the auto, travel, entertainment, and related expenses and the required documents to support charitable contributions for three years from the filing date. It is also your responsibility to carefully examine and approve your completed tax returns before signing them. We are not responsible for the disallowance of doubtful deductions or inadequately supported documentation, nor for resulting taxes, penalties and interest. We will rely, without further verification, upon information you provide to us from third parties including, but not limited to, K1s, 1099s, 1098s, and receipts and similar items. We DO NOT automatically file tax extensions for clients-you must notify us in writing, email or fax if you wish us to file an extension, and the notification should include your estimate of any balance due with the extension. We must receive your information by March 21st in order to complete your return in a timely manner and information received after that date may cause your return to be extended and completed after the April 15th due date. Failure to file an extension may make you subject to various penalties and interest. Additionally, if your return is extended it does not relieve you from paying any tax due on the due date, or making quarterly estimated tax payments for the current year. Failure to pay any tax due with the extension or failure to pay quarterly estimated tax payments may make you subject to various penalties and interest.
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8. We will use our professional judgment in preparing your returns. Whenever we are aware that a possibly applicable tax law is unclear or that there are conflicting interpretations of the law by authorities (e.g., tax agencies and courts), we will explain the possible positions that may be taken on your return. We will adopt whatever position you request on your return so long as it is consistent with the codes, regulations, and interpretations that have been promulgated. If the Internal Revenue Service should later contest the position taken, there may be an assessment of additional tax plus interest and penalties. We assume no liability for any such additional penalties or assessments. 9. We are prohibited from providing confidential information or copies to anyone other than you without your specific, written authorization. To comply with these new regulations we provide all copies of all returns to you. If we are asked to disclose any privileged communication, unless we are required to disclose the communication by law, we will not provide such disclosure until you have had an opportunity to argue that the communication is privileged. You agree to pay any and all reasonable expenses that we incur, including legal fees, that are a result of attempts to protect any communication as privileged. In addition, your confidentiality privilege can be inadvertently waived if you discuss the contents of any privileged communication with a third party, such as a lending institution, a friend, or a business associate. We recommend that you contact us before releasing information to a third party. 11. It is our policy to keep records related to this engagement for three years after which they are destroyed. However, we do not keep any original client records, so we will return those to you at the completion of the services rendered under this engagement. When records are returned to you, it is your responsibility to retain and protect your records for three years for possible future use, including potential examination by any government or regulatory agencies. 12. In the interest of facilitating our services to you, we utilize a secure web portal. Your use of this portal must comply with our standards of use, and as owners of the portal we retain the right to limit and deny use of the portal for inappropriate purposes. Your access to files maintained on the portal will be terminated no later than 30 days after the earlier of your or our termination of services under this agreement or April 15th, unless we are notified in writing of your desire to extend your tax return. All confidential information sent to you or third parties (at your direction), as well as the portal will be password protected. While we will use our best efforts to keep such communications secure in accordance with our obligations under applicable laws and professional standards, you recognize and accept that we have no control over the unauthorized interception of these communications once they have been sent and consent to our use of these devices during this engagement. 13. Payment is due immediately upon completion of work. Our services will conclude upon delivery of the completed income tax returns discussed above or upon our suspension of services or resignation from the engagement. 14. In recognition of the relative risks and benefits of this agreement to both the client and Davis & Ritter CPAs, LLC (“the firm”), the client and the firm have discussed and have agreed on the fair allocation of risk between them. As such, the client agrees, to the fullest extent permitted by law, to limit the liability of the firm to the client for any and all claims, losses, costs, and damages of any nature whatsoever, so that the total aggregate liability of the firm to the client shall not exceed the firm’s total fee for services rendered under this agreement. The client and the firm intend and agree that this limitation apply to any and all liability or cause of action against the firm, however alleged or arising, unless otherwise prohibited by law. Both parties agree that there is a one-year limitation period to bring a claim against the firm for errors and omissions. The one-year period will begin upon the date of the tax professional’s signature on the tax returns covered by this engagement letter. 15. Notwithstanding anything contained herein, both the accountant and client agree that regardless of where the client is domiciled and regardless of where this Agreement is physically signed, this Agreement shall have been deemed to have been entered into at Davis & Ritter CPAs, LLC located in Camp Springs,
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Maryland, in Prince George’s County, USA, and shall be the exclusive jurisdiction for resolving disputes related to this Agreement. This Agreement shall be interpreted and governed in accordance with the Laws of Maryland. 16. In connection with this engagement, we may communicate with you or others via email transmission. As emails can be intercepted and read, disclosed, or otherwise used or communicated by an unintended third party, or may not be delivered to each of the parties to whom they are directed and only to such parties, we cannot guarantee or warrant that emails from us will be properly delivered and read only by the addressee. Therefore, we specifically disclaim and waive any liability or responsibility whatsoever for interception or unintentional disclosure of emails transmitted by us in connection with the performance of this engagement. In that regard, you agree that we shall have no liability for any loss or damage to any person or entity resulting from the use of email transmissions, including any consequential, incidental, direct, indirect, or special damages, such as loss of revenues or anticipated profits, or disclosure or communication of confidential or proprietary information. We appreciate the opportunity to serve you. Please date and sign this letter to acknowledge your agreement with and acceptance of your responsibilities and the terms of this engagement. It is our policy to initiate services after we receive the executed engagement letter. If any provision of this agreement is declared invalid or unenforceable, no other provision of this agreement is affected and all other provisions remain in full force and effect. If you have any questions regarding any of the information above, we would be more than happy to discuss them with you at your convenience. However, if the foregoing services meet with your approval and understanding, you may indicate this by signing in the space provided and returning a signed copy of this letter to Davis & Ritter CPAs, LLC.
Sincerely,
Robert L. Davis, CPA
Crystal D. Davis, CFP®, EA
I (We) have read the above terms of the engagement letter and agree with the terms of this engagement. Client(s) Name ________________________________________ ________________________________________ Signatures ________________________________________ ________________________________________ Date ________________________________________
CERTIF IED PUBLIC ACCOUNTANTS LLC
Park Place Profess ional Center
5871 Al lentown Road Camp Spr ings , MD 20746 -4570
(301) 702 -9300 Fax : (301) 702 -9302
Webs ite: www.dav isr i t ter .com
Page 1 of 2
DAVIS & RITTER
Consent for Disclosure of Tax Return Information
Federal law requires this consent form be provided to you. Unless authorized by law, we cannot
disclose your tax return information to third parties for purposes other than the preparation and
filing of your tax return without your consent. If you consent to the disclosure of your tax return
information, Federal law may not protect your tax return information from further use or
distribution.
You are not required to complete this form to engage our tax return preparation services. If
we obtain your signature on this form by conditioning our tax return preparation services on your
consent, your consent will not be valid. If you agree to the disclosure of your tax return
information, your consent is valid for the amount of time that you specify. If you do not specify
the duration of your consent, your consent is valid for one year from the date of signature.
Consent
I/We authorize Robert L. Davis and Crystal D. Davis (“Preparers”) to disclose all of my Tax Return
Information, which includes but may not be limited to, all communications with Preparers and any
information Preparers derive or generate from Tax Return Information in connection with my 2019
Tax Return(s) (“Tax Return Information”) to: (a) Avantax Investment ServicesSM (AIS), a
registered broker-dealer; (b) Avantax Advisory ServicesSM (AAS), a registered investment adviser;
and (c)affiliates of those entities (collectively, “Avantax”), all of which are headquartered at 6333
N. State Highway 161, Fourth Floor, Irving, Texas 75038. I acknowledge that I may request a
more limited disclosure of Tax Return Information.
I understand that Davis & Ritter CPAs, LLC is not a registered broker-dealer or a registered
investment adviser.
I understand that Preparers are affiliated with Avantax as independent contractors solely for the
purpose of offering financial products and services. Avantax does not offer, provide or supervise
tax advice or tax preparation services, and any services provided by Avantax will be pursuant to a
written agreement directly with the relevant Avantax entity.
I acknowledge that if I make an investment through Avantax that Preparers will receive a part of
any management fees, commissions, or other fees paid on investments I make. I understand that I
am under no obligation whatsoever to follow any recommendations made or to purchase any other
products or services offered by or through Preparers.
Consent for Disclosure of Tax Return Information Page 2 of 2
I understand that the Tax Return Information may not be disclosed or used by Preparers for any
purpose other than as permitted by this consent document.
Purposes
1. This consent allows Preparers to disclose my Tax Return Information to Avantax
for the purpose of providing me with information pertaining to various financial services and
products, which may include, but are not limited to, financial planning, investment advice and
investment products (e.g., stocks, bonds, mutual funds, insurance and annuities). Without limiting
the foregoing, this consent allows Preparers to download my Tax Return Information into financial
planning or other software or systems owned or operated by Preparer or Avantax for the purpose
of assessing my financial situation or providing me with potential investment recommendations,
whether or not I open an account or purchase any products or services through Avantax, and
whether or not such recommendations are actually made.
2. Avantax may capture, retain, and review my electronic communications with
Preparers or other people affiliated with Davis & Ritter CPAs, LLC. These communications may
include email and attachments which contain Tax Return Information. Avantax will protect the
confidential nature of this information by disclosing it only in response to the lawful requests of
United States federal or state agencies, or otherwise as required by law.
3. I understand that Avantax and its authorized third party vendors will retain and
store my Tax Return Information in hard copy and/or electronically as required by applicable
regulations, or longer as determined in the sole discretion of Avantax.
The duration of this consent is three years from the date of signature.
__________________________________________________________________________
Taxpayer Name Signature Date
__________________________________________________________________________
Taxpayer Name (joint return) Signature Date
If you believe your tax return information has been disclosed or used improperly in a manner
unauthorized by law or without your permission, you may contact the Treasury Inspector General
for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email at
CERTIF IED PUBLIC ACCOUNTANTS LLC
Park Place Profess ional Center
5871 Al lentown Road Camp Spr ings , MD 20746 -4570
(301) 702 -9300 Fax : (301) 702 -9302
Webs ite: www.dav isr i t ter .com
Page 1 of 2
DAVIS & RITTER
Consent for Use of Tax Return Information
Federal law requires this consent form be provided to you. Unless authorized by law, we cannot
use your tax return information for purposes other than the preparation and filing of your tax return
without your consent.
You are not required to complete this form to engage our tax return preparation services. If
we obtain your signature on this form by conditioning our tax return preparation services on your
consent, your consent will not be valid. Your consent is valid for the amount of time that you
specify. If you do not specify the duration of your consent, your consent is valid for one year from
the date of signature.
Consent
I/We authorize Robert L. Davis and Crystal D. Davis (“Preparers”) to use all of my Tax Return
Information, which includes but may not be limited to, all communications with Preparers and any
information Preparers derive or generate from Tax Return Information in connection with my 2019
Tax Return(s) (“Tax Return Information”) for the purpose of providing me with information
pertaining to various financial services and products, which may include, but are not limited to,
financial planning, investment advice and investment products (e.g., stocks, bonds, mutual funds,
insurance and annuities).
I understand that Preparers are affiliated with Avantax Investment Servicessm (AIS), a registered
broker-dealer, as independent contractors solely for the purpose of offering financial products and
services.
I understand that Preparers may use all of my Tax Return Information in connection with their
affiliation with (a) Avantax Investment Servicessm; (b) Avantax Advisory Servicessm (AAS), a
registered investment adviser; or (c) affiliates of those entities (collectively, “Avantax”), all of
which are headquartered at 6333 N. State Highway 161, Fourth Floor, Irving, Texas 75038.
Avantax does not offer, provide or supervise tax advice or tax preparation services, and any
services provided by Avantax will be pursuant to a written agreement directly with the relevant
Avantax entity.
I understand that Davis & Ritter CPAs, LLC is not a registered broker-dealer or a registered
investment adviser.
Consent for Use of Tax Return Information Page 2 of 2
I acknowledge that if I make an investment through Avantax that Preparers will receive a part of
any management fees, commissions, or other fees paid on investments I make. I understand that I
am under no obligation whatsoever to follow any recommendations made or to purchase any other
products or services offered by or through Preparers.
I understand that the Tax Return Information may not be disclosed or used by Preparers for any
purpose other than as permitted by this consent document.
Unless otherwise specified below, the duration of this consent is three years from the date of
signature.
If I prefer a more limited duration, I will specify the duration of my consent here: I specify the
duration of the above consent to be _________ years from the date of signature.
__________________________________________________________________________
Taxpayer Name Signature Date
__________________________________________________________________________
Taxpayer Name (joint return) Signature Date
If you believe your tax return information has been disclosed or used improperly in a manner
unauthorized by law or without your permission, you may contact the Treasury Inspector General
for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email at
Social security number . . .
Social security number . . .
CLIENT INFORMATION
DEPENDENTS
First name and initial. . . . .
Last name. . . . . . . . . . . . . . .
Title/suffix. . . . . . . . . . . . . . .
Social security number . . .
Occupation . . . . . . . . . . . . . .
Date of birth (m/d/y). . . . . .
Date of death (m/d/y). . . . .
1=blind. . . . . . . . . . . . . . . . . .
Home phone. . . . . . . . . . . . .
Work phone . . . . . . . . . . . . .
Work extension . . . . . . . . . .
Cell phone. . . . . . . . . . . . . . .
E-mail address. . . . . . . . . . .
In care of. . . . . . . . . . .
Street address. . . . . .
Apartment number. .
City. . . . . . . . . . . . . . . .
State. . . . . . . . . . . . . . .
ZIP code . . . . . . . . . . .
First name. . . . . . . . . . . . . . .
Last name. . . . . . . . . . . . . . .
Title/suffix. . . . . . . . . . . . . . .
Date of birth (m/d/y). . . . . .
Relationship . . . . . . . . . . . . .
Months lived at home . . . .
Tax Return Appointment
Date:Time:Location:
First name. . . . . . . . . . . . . . .
Last name. . . . . . . . . . . . . . .
Title/suffix . . . . . . . . . . . . . . .
Date of birth (m/d/y). . . . . .
Relationship . . . . . . . . . . . . .
Months lived at home . . . .
Taxpayer Spouse
Dependent No. Dependent No.
Dependent No. Dependent No.
Address
1040 US Tax Organizer
Tax Organizer
ORGANIZER
2019
Date of death (m/d/y). . . . .
Date of death (m/d/y). . . . .
Date of adoption (m/d/y). .
Date of adoption (m/d/y). .
Telephone number:Fax number:E-mail address:
This tax organizer will assist you in gathering information necessary for the preparationof your 2019 tax return. Please enter all pertinent 2019 information.
NOTE: If you claim the earned income credit, please provide proof that your child is a resident of the United States. This proof is typically in the formof: school records or statement, landlord or property management statement, health care provider statement, medical records, child care providerrecords, placement agency statement, social service records or statement, place of worship, Indian tribal office statement, or employer statement.
NOTE: If your child is disabled, please provide one of the following forms of proof of disability: doctor statement, other health care provider statement,or social services agency or program statement.
DAVIS & RITTER CPAS, LLC5871 ALLENTOWN ROADCAMP SPRINGS MD 20746-4570
(301) 702-9300
(301) [email protected]
Attach Forms 1099
WAGES, SALARIES AND TIPSEmployer name:
INTEREST INCOMEPayer name:
DIVIDEND INCOMEPayer name:
PENSIONS, IRA AND GAMBLING INCOMEPayer name:
Winnings not reported on W-2G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total gambling losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
OTHER GOVERNMENT FORMS - INCOMEForm 1099-B - Sales of stock (also include transaction history). . . . . .
Form 1099-MISC - Miscellaneous income . . . . . . . . . . . . . . . . . . . . . . . . . . Attach Forms 1099
Form 1099-S - Sales of real estate (also include closing statements)
Form 1099-G - State tax refunds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Attach Forms 1099Taxpayer:
Form SSA-1099 - Social security benefits. . . . . . . . . . . . . . . . . . . . . . . . . .
Form 1099-G - Unemployment compensation. . . . . . . . . . . . . . . . . . . . . . .
Spouse:
Form SSA-1099 - Social security benefits. . . . . . . . . . . . . . . . . . . . . . . . . .
Form 1099-G - Unemployment compensation. . . . . . . . . . . . . . . . . . . . . . .
Please enter all pertinent 2019 information. If you have attacheda government form for an item, check the box and do not enter a 2019 amount.
Attach Forms W-2
Attach Forms 1099-INT
Attach Forms 1099-DIV
Attach Forms1099-R & W-2G
Attach Forms 1099
1040 US Tax Organizer
Tax Organizer
ORGANIZER
Form 1099-K - Merchant card and third party network payments. . . . .
2019
2019 Amount 2018 Amount
Form 1099-Q (529 Plan). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Form 1099-QA/5498-QA (ABLE Accounts). . . . . . . . . . . . . . . . . . . . . . . . . .
Form 1099-Q (529 Plan). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Form 1099-QA/5498-QA (ABLE Accounts). . . . . . . . . . . . . . . . . . . . . . . . . .
RETIREMENT PLAN CONTRIBUTIONSTaxpayer: Traditional IRA contributions (1=maximum). . . . . . . . . . . . . . . . . . . . .
Roth IRA contributions (1=maximum) . . . . . . . . . . . . . . . . . . . . . . . . . .
Self-employed, SEP, SIMPLE, & qualified plan contributions (1=maximum). . . . . .
Spouse: Traditional IRA contributions (1=maximum). . . . . . . . . . . . . . . . . . . . .
Roth IRA contributions (1=maximum) . . . . . . . . . . . . . . . . . . . . . . . . . .
Self-employed, SEP, SIMPLE, & qualified plan contributions (1=maximum). . . . . .
MEDICAL AND DENTAL EXPENSESPrescription medicines and drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Doctors, dentists and nurses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hospitals and nursing homes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Insurance premiums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Long-term care premiums - taxpayer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Long-term care premiums - spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Insurance reimbursement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Out-of-pocket lodging and transportation expenses. . . . . . . . . . . . . . . . . . . . . . .
Number of medical miles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other:
OTHER GOVERNMENT FORMS - DEDUCTIONSForm 1098-E - Student loan interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Form 1098-T - Tuition and related expenses . . . . . . . . . . . . . . . . . . . . . . . . . Attach Forms 1098
ADJUSTMENTS TO INCOMETaxpayer:
Self-employed health insurance premiums. . . . . . . . . . . . . . . . . . . . . . . . . . .
Educator expenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other adjustments to income:
Alimony paid - Recipient name & SSN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Spouse:
Self-employed health insurance premiums. . . . . . . . . . . . . . . . . . . . . . . . . . .
Educator expenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other adjustments to income:
Alimony paid - Recipient name & SSN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TAXES PAIDState income taxes - 1/19 payment on 2018 state estimate. . . . . . . . . . . . . . .
1040 US Tax Organizer
Tax Organizer
ORGANIZER
2019
2019 Amount 2018 Amount
Attach Forms 1095
AFFORDABLE CARE ACTForm 1095-A - Health Insurance Marketplace Statement. . . . . . . . . . . . . .
Form 1095-B - Health Coverage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Form 1095-C - Employer-Provided Health Insurance Offer and Coverage. . . . . .
MISCELLANEOUS INCOMETaxpayer: Alimony received. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Spouse: Alimony received. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other:
CASH CONTRIBUTIONS
Volunteer expenses (out-of-pocket). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Number of charitable miles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
INTEREST PAIDHome mortgage interest and points paid:
Home mortgage interest not on Form 1098 (include name, SSN, & address of payee):
Points not reported on Form 1098:
Mortgage insurance premiums on post 12/31/06 contracts . . . . . . . . . . . . . . . .
Investment interest (interest on margin accounts):
Passive interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NONCASH CONTRIBUTIONS
MISCELLANEOUS DEDUCTIONSUnion and professional dues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax return preparation fee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Safe deposit box rental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Investment expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Estate tax, section 691(c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unreimbursed employee expenses:
Other:
TAXES PAID (continued)
Personal property taxes (including automobile fees in some states) . . . Attach Tax Notice
City/local income taxes - paid with 2018 city/local extension . . . . . . . . . . . . . .
City/local income taxes - paid with 2018 city/local return. . . . . . . . . . . . . . . . . .
State and local sales taxes (except autos and special items) . . . . . . . . . . . . .
Use taxes paid on 2019 purchases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Use taxes paid on 2018 state return. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sales tax on autos not included above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sales taxes paid on boats, aircraft, and other special items. . . . . . . . . . . . . . .
Real estate taxes - principal residence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Real estate taxes - property held for investment . . . . . . . . . . . . . . . . . . . . . . . . .
Foreign income taxes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NOTE: No deduction is allowed for cash or check contributions unless the donor maintains a bank record, or a written communicationfrom the donee, showing the name of the organization, contribution date(s), and contribution amount(s).
NOTE: No deduction is allowed for contributions of clothing and household items that are not in good used condition or better, in addition,a deduction for any item with minimal monetary value may be denied.
Attach Forms 1098
1040 US Tax Organizer
Tax Organizer
ORGANIZER
2019
2019 Amount 2018 Amount
City/local income taxes - 1/19 payment on 2018 city/local estimate. . . . . . . .
State income taxes - paid with 2018 state extension . . . . . . . . . . . . . . . . . . . . .
State income taxes - paid with 2018 state return. . . . . . . . . . . . . . . . . . . . . . . . .
State income taxes - paid for prior years and/or to other states. . . . . . . . . . .
YES NO
Did your marital status change during the year?
Did your address change during the year?
Could you be claimed as a dependent on another person's tax return?
Were there any changes in dependents?
Did you receive unreported tip income of $20 or more in any month?
Did you receive any disability income?
Did you buy or sell any stocks, bonds or other investment property?
Did you purchase, sell, or refinance your principal home or second home, or did you take a home equity loan?
Did you convert part or all of your traditional/SEP/SIMPLE IRA to a Roth IRA?
Did you incur a loss because of damaged or stolen property?
Did you use your car on the job (other than to and from work)?
May the IRS discuss your tax return with your preparer?
Was your home rented out or used for business?
Were you notified or audited by either the IRS or the State taxing agency?
Did you receive a distribution from or make a contribution to a retirement plan (401(k), IRA, etc.)?
Did you transfer or rollover any amount from one retirement plan to another?
If any of the following items pertain to you or your spouse for 2019, please check theappropriate box and provide additional information if necessary.
Did you make any residential energy-efficient improvements or purchases involving solar, wind, geothermal or fuel cellenergy sources?
Did you, your spouse, or a dependent incur any tuition expenses that are required to attend a college, university, orvocational school?
1040 US Miscellaneous Questions
Miscellaneous Questions
ORGANIZER
2019
Did you and your dependents have health care coverage for the full-year?
Did you receive an IRS document 1095-A (Health Insurance Marketplace Statement)? If so, please attach.
